Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2015

Open Access 01-12-2015 | Study protocol

Frequency and change mechanisms of psychotherapy among depressed patients: study protocol for a multicenter randomized trial comparing twice-weekly versus once-weekly sessions of CBT and IPT

Authors: Sanne J. E. Bruijniks, Judith Bosmans, Frenk P. M. L. Peeters, Steven D. Hollon, Patricia van Oppen, Michael van den Boogaard, Pieter Dingemanse, Pim Cuijpers, Arnoud Arntz, Gerdien Franx, Marcus J. H. Huibers

Published in: BMC Psychiatry | Issue 1/2015

Login to get access

Abstract

Background

Cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) are among the most well established therapies for the treatment of depression. However, some major questions remain unanswered. First, it is unknown what session frequency results in the most optimal (cost) effectiveness in psychotherapy. Second, the debate as to what mechanisms underlie the effect of psychotherapy has not yet been resolved. Enhancing knowledge about the optimal session frequency and mechanisms of change seems crucial in order to optimize the (cost) effectiveness of psychotherapy for depression. This study aims to compare treatment outcome of twice-weekly versus once-weekly sessions of CBT and IPT. We expect twice-weekly sessions to be more effective and lead to more rapid recovery of depressive symptoms in comparison to once-weekly sessions. Both therapy-specific and non-specific process measures will be included to unravel the mechanisms of change in psychotherapy for depression. Besides the use of self-reports and behavioral observations, this study will also examine underlying biological processes by collecting blood samples.

Method

In a multicenter randomized trial, two hundred depressed patients will be recruited from Dutch specialized mental healthcare centers and randomized into one of the following groups, all receiving a maximum of 20 sessions in different frequencies: a) twice-weekly sessions at the start of CBT, b) twice-weekly sessions at the start of IPT, c) once-weekly sessions at the start of CBT, d) once-weekly sessions at the start of IPT. Primary outcome measures are depression severity, cost-effectiveness and quality of life. Process measures include therapeutic alliance, recall, therapy-specific skills, motivation and compliance. Assessments will take place during baseline, monthly during treatment and follow-up at month 9, 12 and 24. In addition, at 12 and 24 months, the frequency of depressive episodes in the previous year will be assessed. Blood samples will be taken pre- and post-treatment. The study has been ethically approved and registered.

Discussion

Finding that twice-weekly sessions are more effective or lead to more rapid recovery of depressive symptoms could lead to treatment adaptations that have the potential to reduce the personal and societal burden of depression. In addition, insight into the mechanisms of change and physiological processes in psychotherapy will enable us to optimize treatments and may help to understand human functioning beyond the context of treatment.

Trial registration

The study has been registered on October 21th, 2014 at the Netherlands Trial Register, part of the Dutch Cochrane Centre (NTR4856).
Literature
1.
Beck AT et al. Cognitive therapy of depression. New York: Guilford; 1979.
2.
Klerman GL et al. Interpersonal psychotherapy for depression. New York: Basic Books; 1984.
3.
Cuijpers P, van Straten A, Andersson G, van Oppen P. Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies. J Consult Clin Psychol. 2008;76(6):909.PubMedCrossRef
4.
Butler AC, Chapman JE, Forman EM, Beck AT. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev. 2006;26(1):17–31.PubMedCrossRef
5.
Cuijpers P, Geraedts AS, van Oppen P, Andersson G, Markowitz JC, van Straten A. Interpersonal psychotherapy of depression: a meta-analysis. Am J Psychiatry. 2011;168:581–92.PubMedPubMedCentralCrossRef
6.
7.
Cuijpers P, Huibers M, Daniel Ebert D, Koole SL, Andersson G. How much psychotherapy is needed to treat depression? A metaregression analysis. J Affect Disord. 2013;149(1–3):1–13.PubMedCrossRef
8.
Garratt G, Ingram RE, Rand KL, Sawalani G. Cognitive processes in cognitive therapy: Evaluation of the mechanisms of change in the treatment of depression. Clinical Psychology: Science and Practice. 2007;14(3):224–39.
9.
Budd R, Hughes I. The Dodo Bird Verdict—controversial, inevitable and important: a commentary on 30 years of meta‐analyses. Clin Psychol Psychother. 2009;16(6):510–22.PubMedCrossRef
10.
Pachankis JE, Goldfried MR. On the next generation of process research. Clin Psychol Rev. 2007;27(6):760–8.PubMedCrossRef
11.
12.
Luborsky L, Rosenthal R, Diguer L, Andrusyna TP, Berman JS, Levitt JT, Krause ED. The dodo bird verdict is alive and well—mostly. Clinical Psychology: Science and Practice. 2002;9(1):2–12.
13.
Kazdin AE. Mediators and mechanisms of change in psychotherapy research. Annu Rev Clin Psychol. 2007;3:1–27.PubMedCrossRef
14.
Lorenzo-Luaces L, German R. E, DeRubeis R. J. It's complicated: The relation between cognitive change procedures, cognitive change, and symptom change in cognitive therapy for depression. Clinical psychology review. 2014, doi:10.​1016/​j.​cpr.​2014.​12.​003.
15.
16.
Abramowitz JS, Foa EB, Franklin ME. Exposure and ritual prevention for obsessive-compulsive disorder: Effects of intensive versus twice-weekly sessions. J Consult Clin Psychol. 2003;71(2):394.PubMedCrossRef
17.
Herbert JD, Rheingold AA, Gaudiano BA, Myers VH. Standard versus extended cognitive behavior therapy for social anxiety disorder: A randomized-controlled trial. Behav Cogn Psychother. 2004;32(02):131–47.CrossRef
18.
Reese RJ, Toland MD, Hopkins NB. Replicating and extending the good-enough level model of change: Considering session frequency. Psychother Res. 2011;21(5):608–19.PubMedCrossRef
19.
DeRubeis RJ, Hollon SD, Amsterdam JD, Shelton RC, Young PR, Salomon RM, O’Reardon JP, Lovett ML, Gladis MM, Brown LL, Gallop R. Cognitive therapy vs. medications in the treatment of moderate to severe depression. Arch Gen Psychiatry. 2005;62:409–16.PubMedCrossRef
20.
Dimidjian S, Hollon SD, Dobson KS, Schmaling KB, Kohlenberg RJ, Addis ME, Gallop R, McGlinchey JB, Markley DK, Gollan JK, Atkins DC, Dunner DL, Jacobson NS. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. J Consult Clin Psychol. 2006;74:658–70.PubMedCrossRef
21.
Jakobsen JC, Hansen JL, Simonsen S, Simonsen E, Gluud C. Effects of cognitive therapy versus interpersonal psychotherapy in patients with major depressive disorder: a systematic review of randomized clinical trials with meta-analyses and trial sequential analyses. Psychol Med. 2012;42(07):1343–57.PubMedCrossRef
22.
Kazdin AE. Understanding how and why psychotherapy leads to change. Psychother Res. 2009;19(4–5):418–28.PubMedCrossRef
23.
Preacher KJ, Zhang Z, Zyphur MJ. Alternative methods for assessing mediation in multilevel data: The advantages of multilevel SEM. Structural Equation Modeling. 2011;18(2):161–82.CrossRef
24.
Bordin ES. The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice. 1979;16(3):252.CrossRef
25.
Lambert MJ, Barley DE. Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, Research, Practice, Training. 2001;38(4):357.CrossRef
26.
Flückiger C, Del Re AC, Wampold BE, Symonds D, Horvath AO. How central is the alliance in psychotherapy? A multilevel longitudinal meta-analysis. J Couns Psychol. 2012;59(1):10.PubMedCrossRef
27.
Samstag L. W, Batchelder S. T, Muran J. C, Safran J. D. Winston A. Early identification of treatment failures in short-term psychotherapy: An assessment of therapeutic alliance and interpersonal behavior. J Psychotherapy Practice & Res. 1998;7(2):126-143.
28.
Henn FA, Vollmayr B. Neurogenesis and depression: etiology or epiphenomenon? Biol Psychiatry. 2004;56(3):146–50.PubMedCrossRef
29.
Shimizu E, Hashimoto K, Okamura N, Koike K, Komatsu N, Kumakiri C, Iyo, M. Alterations of serum levels of brain-derived neurotrophic factor (BDNF) in depressed patients with or without antidepressants. Biol Psychiatry. 2003;54(1):70–5.PubMedCrossRef
30.
Brunoni AR, Lopes M, Fregni F. A systematic review and meta-analysis of clinical studies on major depression and BDNF levels: implications for the role of neuroplasticity in depression. Int J Neuropsychopharmacol. 2008;11(08):1169–80.PubMedCrossRef
31.
Perroud N, Salzmann A, Prada P, Nicastro R, Hoeppli ME, Furrer S, Malafosse, A. Response to psychotherapy in borderline personality disorder and methylation status of the BDNF gene. Translational Psychiatry. 2013;3(1):207.CrossRef
32.
Fuchikami M, Morinobu S, Segawa M, Okamoto Y, Yamawaki S, Ozaki N, Terao, T. DNA methylation profiles of the brain-derived neurotrophic factor (BDNF) gene as a potent diagnostic biomarker in major depression. PLoS One. 2011;6(8), e23881.PubMedPubMedCentralCrossRef
33.
Slattery DA, Neumann ID. Oxytocin and major depressive disorder: experimental and clinical evidence for links to aetiology and possible treatment. Pharmaceuticals. 2010;3(3):702–24.PubMedCentralCrossRef
34.
Scantamburlo G, Hansenne M, Fuchs S, Pitchot W, Maréchal P, Pequeux C, Legros JJ. Plasma oxytocin levels and anxiety in patients with major depression. Psychoneuroendocrinology. 2007;32(4):407–10.PubMedCrossRef
35.
Zetzsche T, Frasch A, Jirikowski G, Murck H, Steiger A. Nocturnal oxytocin secretion is reduced in major depression. Biol Psychiatry. 1996;39(7):584.CrossRef
36.
Redei EE, Andrus BM, Kwasny MJ, Seok J, Cai X, Ho J, Mohr DC. Blood transcriptomic biomarkers in adult primary care patients with major depressive disorder undergoing cognitive behavioral therapy. Translational Psychiatry. 2014;4(9):e442.PubMedPubMedCentralCrossRef
37.
Beck AT, Steer RA, Carbin MG. Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clin Psychol Rev. 1988;8(1):77–100.CrossRef
38.
Beck AT, Steer R, Brown GK. Beck Depression Inventory II. Manual Boston: Hartcourt Brace; 1996.
39.
van der Does W. BDI-II-NL: Handleiding; De Nederlandse versie van de Beck Depressie Inventory. 2nd ed. Enschede: Ipskamp; 2002.
40.
First MB, Spitzer RL, Gibbon M, Williams JB. Structured Clinical Interview for DSM-IV® Axis I Disorders (SCID-I), Clinician Version. American Psychiatric Pub: Administration Booklet; 2012.
41.
Van Vliet, IM, Leroy, H, Van Megen, HJGM. MINI plus. MINI Internationaal Neuropsychiatrisch Interview, Nederlandse versie 5.0. 0. 2000.
42.
Whisman, M. A, Perez, J. E, Ramel W. Factor structure of the Beck Depression Inventory—Second Edition (BDI-II) in a student sample. J Clinical Psychology. 2000;56(4):545-551.
43.
EuroQol G. EuroQol--a new facility for the measurement of health-related quality of life. Health policy (Amsterdam, Netherlands). 1990;16(3):199.CrossRef
44.
Lamers LM, McDonnell J, Stalmeier PF, Krabbe PF, Busschbach JJ. The Dutch tariff: results and arguments for an effective design for national EQ‐5D valuation studies. Health Econ. 2006;15(10):1121–32.PubMedCrossRef
45.
Zimmerman M, Martinez JH, Attiullah N, Friedman M, Toba C, Boerescu DA. The remission from depression questionnaire as an outcome measure in the treatment of depression. Depress Anxiety. 2013;31(6):533–8.PubMedCrossRef
46.
Peeters F, Nicolson N, Wichers M, Hacker P. Dutch translation RDQ. Maastricht: Dep. of Psychiatry and Psychology; 2013.
47.
48.
van der Zee KI, Sanderman R. Het meten van de algemene gezondheidstoestand met de RAND-36: een handleiding Groningen: Noordelijk Centrum voor Gezondheidsvraagstukken. 1993.
49.
Keller MB, Lavori PW, Friedman B, Nielsen E, Endicott J, McDonald-Scott P, et al. The Longitudinal Interval Follow-up Evaluation: A Comprehensive Method for Assessing Outcome in Prospective Longitudinal Studies. Arch Gen Psychiatry. 1987;44:540–8.PubMedCrossRef
50.
Warshaw MG, Dyck I, Allsworth J, Stout RL, Keller MB. Maintaining reliability in a long-term psychiatric study: an ongoing inter-rater reliability monitoring program using the longitudinal interval follow-up evaluation. J Psychiatr Res. 2001;35:297–305.PubMedCrossRef
51.
Warshaw MG, Keller MB, Stout RL. Reliability and Validity of the Longitudinal interval follow-up evaluation for assessing outcome of anxiety disorders. J Psychiatr Res. 1994;28:531–45.PubMedCrossRef
52.
Hakkaart-van Roijen L. Handleiding Trimbos/iMTA questionnaire for Costs associated with Psychiatric illness (TiC-P). Rotterdam: Trimbos/iMTA; 2010.
53.
Hakkaart-van Roijen L, Tan SS, Bouwmans CAM. Handleiding voor kostenonderzoek: Methoden en standaard kostprijzen voor economische evaluaties in de gezondheidszorg. Geactualiseerde versie 2010 [Dutch manual for costing in economic evaluations]. Diemen: College voor zorgverzekeringen (CVZ); 2011.
54.
Z-index S. G-Standaard. Den Haag: Z-index; 2006.
55.
Horvath AO, Greenberg LS. Development and validation of the Working Alliance Inventory. J Couns Psychol. 1989;36(2):223.CrossRef
56.
Busseri MA, Tyler JD. Interchangeability of the Working Alliance Inventory and Working Alliance Inventory, Short Form. Psychol Assess. 2003;15(2):193.PubMedCrossRef
57.
Tichenor V, Hill CE. A comparison of six measures of working alliance. Psychotherapy: Theory, Research, Practice, Training. 1989;26(2):195.CrossRef
58.
Tracey TJ, Kokotovic AM. Factor structure of the Working Alliance Inventory. Psychol Assess. 1989;1(3):207.CrossRef
59.
Vertommen H, Vervaeke GAC. Werkalliantievragenlijst (wav). In: Vertaling voor experimenteel gebruik van de wai (Horvath & Greenberg 1986). Niet-gepubliceerde vragenlijst. kuLeuven: Departement Psychologie; 1990.
60.
61.
Zuroff DC, Koestner R, Moskowitz DS, McBride C, Marshall M, Bagby MR. Autonomous motivation for therapy: A new common factor in brief treatments for depression. Psychother Res. 2007;17(2):137–47.CrossRef
62.
Williams GC, Freedman ZR, Deci EL. Supporting autonomy to motivate patients with diabetes for glucose control. Diabetes Care. 1998;21(10):1644–51.PubMedCrossRef
63.
Raes F, Hoes D, Van Gucht D, Kanter JW, Hermans D. The Dutch version of the behavioral activation for depression scale (BADS): Psychometric properties and factor structure. J Behav Ther Exp Psychiatry. 2010;41(3):246–50.PubMedCrossRef
64.
Hill CE, O’Grady KE, Elkin I. Applying the Collaborative Study Psychotherapy Rating Scale to rate therapist adherence in cognitive-behavior therapy, interpersonal therapy, and clinical management. J Consult Clin Psychol. 1992;60(1):73.PubMedCrossRef
65.
66.
Diefendorff JM, Hall RJ, Lord RG, Strean ML. Action–state orientation: Construct validity of a revised measure and its relationship to work-related variables. J Applied Psychology. 2000;85(2):250.CrossRef
67.
Strunk DR, Hollars SN, Adler AD, Goldstein LA, Braun JD. Assessing Patients’ Cognitive Therapy Skills: Initial Evaluation of the Competencies of Cognitive Therapy Scale. Cognitive Therapy and Res. 2014;1–11.
68.
Strunk DR, DeRubeis RJ, Chiu AW, Alvarez J. Patients’ competence in and performance of cognitive therapy skills: relation to the reduction of relapse risk following treatment for depression. J Consult Clin Psychol. 2007;75(4):523.PubMedCrossRef
69.
Bernstein DP, Stein JA, Newcomb MD, Walker E, Pogge D, Ahluvalia T, Zule W. Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse Negl. 2003;27(2):169–90.PubMedCrossRef
70.
Scher CD, Stein MB, Asmundson GJ, McCreary DR, Forde DR. The childhood trauma questionnaire in a community sample: psychometric properties and normative data. J Trauma Stress. 2001;14(4):843–57.PubMedCrossRef
71.
Thombs BD, Bernstein DP, Lobbestael J, Arntz A. A validation study of the Dutch Childhood Trauma Questionnaire-Short Form: Factor structure, reliability, and known-groups validity. Child Abuse Negl. 2009;33(8):518–23.PubMedCrossRef
72.
Steer RA, Beck AT, Clark DA, Beck JS. Psychometric properties of the Cognition Checklist with psychiatric outpatients and university students. Psychol Assess. 1994;6(1):67.CrossRef
73.
Braver TS, Cohen JD, Nystrom LE, Jonides J, Smith EE, Noll DC. A parametric study of prefrontal cortex involvement in human working memory. Neuroimage. 1997;5(1):49–62.PubMedCrossRef
74.
Moradveisi L, Huibers M, Renner F, Arntz A. The influence of patients’ preference/attitude towards psychotherapy and antidepressant medication on the treatment of major depressive disorder. J Behav Ther Exp Psychiatry. 2014;45(1):170–7.PubMedCrossRef
75.
Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991;59(1):12.PubMedCrossRef
76.
Evans C, Margison F, Barkham M. The contribution of reliable and clinically significant change methods to evidence-based mental health. Evidence Based Mental Health. 1998;1(3):70–2.CrossRef
77.
Lemmens LJHM, Galindo-Garre F, Arntz A, Peeters F, Hollon SD, DeRubeis R.J, Huibers MJH. Exploring Mechanisms of Change in Cognitive Therapy and Interpersonal Psychotherapy for adult Depression. (submitted).
78.
Fenwick E, O’Brien BJ, Briggs A. Cost‐effectiveness acceptability curves–facts, fallacies and frequently asked questions. Health Econ. 2004;13(5):405–15.PubMedCrossRef
Metadata
Title
Frequency and change mechanisms of psychotherapy among depressed patients: study protocol for a multicenter randomized trial comparing twice-weekly versus once-weekly sessions of CBT and IPT
Authors
Sanne J. E. Bruijniks
Judith Bosmans
Frenk P. M. L. Peeters
Steven D. Hollon
Patricia van Oppen
Michael van den Boogaard
Pieter Dingemanse
Pim Cuijpers
Arnoud Arntz
Gerdien Franx
Marcus J. H. Huibers
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2015
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-015-0532-8

Other articles of this Issue 1/2015

BMC Psychiatry 1/2015 Go to the issue

Research article

Using films as a psychoeducation tool for patients with schizophrenia: a pilot study using a quasi-experimental pre-post design

Commentary

A shared framework for the common mental disorders and Non-Communicable Disease: key considerations for disease prevention and control

Research article

Mental health literacy measures evaluating knowledge, attitudes and help-seeking: a scoping review

Research article

A systematic review for the antidepressant effects of sleep deprivation with repetitive transcranial magnetic stimulation

Research article

Challenges for group leaders working with families dealing with early psychosis: a qualitative study

Research article

Treatment received and treatment adequacy of depressive disorders among young adults in Finland